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Solutions for Providers

The industry’s evolution from fee-for-service to value-based care represents a challenge to traditional healthcare business models. Today’s healthcare providers need to adapt to new ways of thinking and operating. We help health care delivery organizations identify, understand, and act on emerging opportunities to transform their operations and improve their clinical and financial performance.

Providers

DIY Workflow and Report Design. Our applications are built for self-service, reducing or eliminating the need for consultants and system integrators to customize our software to your needs. Launch our apps, and realize value immediately.

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High Accolades for Customer Satisfaction. We hold high accolades for customer satisfaction. Our applications have been named Best in KLAS for three years, and in 2021 we are cited for excellence by KLAS Research for customer satisfaction and partnerships.

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A Legacy of Innovation. We bring a 30-year legacy of HIT innovation. Our software and services were developed by providers, for providers. We were among the first to combine technology and services to administer bundled payments, and the first to codify medical evidence as algorithms to evaluate clinical data and display it as decision support in the EHR.

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COORDINATE CARE & REDUCE VARIATION

Success in value-based care hinges on alignment between analytics insights and care team activities. Analytics-guided care coordination and clinical decision support ensures that care gaps and treatment opportunities that represent the greatest clinical and financial impact are addressed during in-person and virtual points of care. Care coordination and care delivery applications simplify and expedite treatment decisions and workflows, ensuring priority interventions are addressed, while minimizing variations in care.

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Close More Care Gaps

Addressing care gaps in the patient population is a proven way to improve population health while increasing reimbursement potential under fee-for-service and value-based payment models. Our care coordination and delivery solutions increase the efficacy of care teams by identifying cohorts with the care gaps that align with payer contract parameters.

Improve Team Satisfaction

Healthcare delivery organizations across the country are faced with a provider burnout epidemic stemming from inefficient processes that require manual repetition. Our solutions, designed by providers for providers, help care coordinators spend less time doing redundant tasks though role-based tasking features. This ensures activities are assigned to the appropriate team member, enabling top-of license work.

Visualize Treatment Opportunities

For value-based care, maximizing virtual and in-person office visits means addressing as many care gaps as possible. Our clinical decision support tools surface treatment and prevention opportunities at a glance through an award-winning dashboard, used by providers during interactions with patients.

Integrate Insights In The Provider’s Workflow

Reducing click fatigue and redundant task is one way of reducing provider burnout. Our clinical decision support tools can embed in the EHR and feature bi-directional data integration. This keeps providers within the established workflows and reduces the need to enter the same data into multiple systems.

PROMOTE HIGH PERFORMANCE NETWORKS

To remain competitive and profitable amid declining fee-for-service revenue, healthcare delivery organizations can access new patients and lines of business by developing high-performance provider networks that align with alternative payment models, like bundled payments. Our bundles administration applications and services include bundles design, network development, credentialing and contracting, and value-based care payment administration. Our tools, consulting and outsourced services can help position your healthcare delivery organization for new business as employers seek to engage directly with providers in centers of excellent and high performing, primary care networks.

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PRIMARY, SPECIALTY, AND GLOBAL CAPITATION ADJUDICATION

Independent physician associations and managed services organizations handling delegated risk agreements are faced with inefficient and inaccurate claims management, resulting in higher operational costs. Our capitation administration applications feature self-service tools that automate and increase precision of the repetitive tasks of claims data management, payment processing, and reimbursement.

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Drive Accurate Adjudication

Multiple capitated contracts and fee schedules across various lines of business increase the likelihood of administrative errors. Our core administrative processing system features automated processes that help ensure correct coding, grouping, pricing, and payment. It automatically attaches authorizations to the claim, generates letters, adjudicates the claims, and tracks activity for compliance reporting.

Access Flexible Capabilities

Systems able to accommodate diverse payment models allow clients to minimize software expenses. Our claims administration solution can take on capitated and fee-for-service payment agreements.

Facilitate Accurate Payment

Unpredictable and often delayed cash collections create financial challenges for the organization, including overreliance on lines of credit. Our financial management tools pinpoint variation in payment, enabling clients to identify problems within the process and take action.

Automate Redundant Tasks

Processes such as authorizations and referrals are time and resource intensive. Our capitation administration application determines eligibility and matches auto-adjudication tables to approve or deny authorizations and generates the corresponding letter.

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Case Study

A Health System’s Journey to Value Leads to a $44M Performance Improvement

One of the largest Catholic healthcare systems in the Midwest, embarked on a value-based care journey through its ACO.

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Case Study

The Christ Hospital Health Network Expands Successful Care Coordination Pilot Across Practices with New People, Processes and Technology

The Christ Hospital Health Network (The Christ) is a nationally recognized, integrated delivery system located in Cincinnati, Ohio that is focused on improving community health and creating patient value by providing affordable care and exceptional outcomes. Anchored by its 555-bed acute care hospital and a network of 200-plus providers, The Christ delivers primary and specialty care services to more than 200,000 patients through 36 ambulatory clinics and sites.

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Case Study

Chronic Care Management and Transitional Care Management

Healthcare Network of Southwest Florida (HCN) was founded in 1977 to address the health issues of migrant and seasonal farm workers, rural poor, and other citizens in Florida’s Collier County. Today, HCN’s federally qualified health center (FQHC) serves the area’s uninsured and under-insured population which includes people of Hispanic and Haitian descent, and where language, transportation, and social issues can complicate the provision of services. A population health management (PHM) initiative was key to helping HCN continue its efforts to provide the highest quality, comprehensive, and affordable healthcare.

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Case Study

Actionable Analytics Improve Patient Navigation

An integrated health system in the southeast sought to create a better way to direct patients…

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EXPLORE SOLUTIONS

The right solution for your value-based journey is only a click away. Our modular technology is quickly and easily integrated into current systems and complements existing IT investments so that we can grow with you. Learn more today!

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